Nasal powder may be simpler option than injection

STOCKHOLM -- Adult volunteers and caregivers were more successful at using glucagon nasal powder devices than traditional injections to treat a patient with severe hypoglycemia in a simulated situation, researchers said here.

The devices are single-use and are designed to shoot a dry powder up the nose in rescue situations. In the study, 16 caregivers were paired with a diabetes patient, who taught the caregivers how to use either a needle with glucagon and powder or glucagon nasal powder.

One week later, caregivers were asked to treat a manikin. Fifteen of the 16 caregivers successfully administered a full dose with the nasal device, compared to only eight of 16 with injection rescues, said author Jean-François Yale, MD, at McGill University in Canada, who presented the findings during a poster session here at the 51st annual meeting of the European Association for the Study of Diabetes.

A separate group tested 15 volunteers, who were not associated with anybody who had diabetes and were not trained, but were shown the devices prior to the simulation. Only three of the participants in the volunteer group injected any glucagon with the needle, and none gave a full dose. In comparison, 14 of 15 volunteers injected a full dose with the glucagon nasal powder device.

Joel Zonszein, MD, of the Albert Einstein College of Medicine in New York who was not associated with this study, said that in the study, even with training, many still failed to inject glucagon, "which is what we see in clinical practice."

He added that the nasal powder seems easier to administer. "There were no clinical outcomes, however," he said. "But we certainly need better, easier, and less expensive devices to better treat hypoglycemia."

Previous research -- reported at the American Diabetes Association's annual meeting earlier this year -- showed that the device was safe and effective in children and teens. A spokesperson for Locemia Solutions, which makes the device, said these new results follow data from a phase III trial earlier this year, that showed that the powder was as effective as reversing hypoglycemia in adults as injected glucagon.

"We know hypoglycemia is a very problematic aspect of diabetes care -- it's very stressful for diabetics," said Yale in an interview with MedPage Today. "The results from the injections were frightening. In only 50% of cases were they able to give any glucagon with injection, and in only 12% did they give the full dose."

Two caregivers and one volunteer in the study injected insulin after getting confused by the similar forms of the glucagon rescue kit and the insulin vial and needle. The simulation included sound effects and distraction in an attempt to mimic the sense of emergency that can accompany episodes of severe hypoglycemia. The manikin had a backpack on, and participants were told to find the rescue kit -- with either the needle or the nasal device -- and to administer as quickly as possible. The backpack also contained a diabetes supply pouch with a glucometer and strips, alcohol swabs, lancing device, insulin syringe, and a vial of insulin.

The two participants who did not succeed in administering a full dose of glucagon with the nasal device failed to fully depress the plunger. Both of them also failed to inject a full dose. Failures of the acquaintances to inject a full dose included a bent needle and injection of diluent only. One participant refused to inject and another injected with an empty syringe.

Yale is a consultant for Locemia Solutions, which makes the devices containing glucagon nasal powder. He also disclosed relationships with Eli Lilly.

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